The scapulothoracic bursa lies between the subscapularis muscle (on the costal scapular surface) and the serratus anterior muscle overlying the posterior chest wall. It is not a true anatomical bursa in most individuals but develops as an adventitial bursa in response to scapulothoracic friction. The scapulothoracic joint is a physiological joint where the scapula glides smoothly on the chest wall during shoulder elevation.
Scapulothoracic crepitus (scapular snapping) results from friction between the scapular undersurface and the chest wall, causing an audible and palpable snapping during shoulder elevation. This may be from an inflamed scapulothoracic bursa, a bony prominence (osteochondroma of the superomedial scapular angle or underlying rib), or muscle wasting creating bony prominence. Scapulothoracic bursitis is treated by corticosteroid injection between the serratus anterior and subscapularis. Surgical bursectomy and smoothing of the scapular angle treats refractory cases.
Scapulothoracic bursa inflammation or a bony prominence at the superomedial scapular angle produces a palpable and sometimes audible snap during shoulder elevation from impingement between the scapular undersurface and the chest wall; managed by bursal injection and physiotherapy, with surgical bursectomy and scapular angle reshaping for refractory cases.
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